Following are briefs from studies and guidelines published in the March issue of Neurology, the scientific journal of the American Academy of Neurology (AAN).
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ona Stewart at 612-623-8115 or by e-mail
Proper Management of Sports-Related Concussion Can Prevent Years of Chronic Headaches, Confusion and Memory Loss Harry Carson spent 13 years with the New York Giants, and built a reputation as one of the toughest and most feared inside linebackers ever to play the game. He was known for his big hits, his leadership, and his ability to play through the pain. He was not known, however, for the concussions he received from years of helmet-to-helmet contact as a run-stopper. Carson joined the American Academy of Neurology (AAN) and the Brain Injury Association (BIA) in presenting new guidelines on managing concussion in sports. The guidelines were published in the March issue of Neurology, the AANÃs scientific journal. Developed by the AAN and endorsed by 14 other prominent medical and athletic organizations, these guidelines are the first attempt to develop a consensus on the best way to evaluate and manage athletes who suffer a concussion during athletic competition.
ìA concussion is a head injury in which the brain is shaken or banged against the skull,î said neurologist James P. Kelly, MD, co-author of the AANÃs Practice Parameter on the Management of Concussion in Sports and director of the Brain Injury Program at the Rehabilitation Institute of Chicago.
ìPeople throw around the phrase ëminor concussion,à but there is no such thing as a ëminorà concussion,î said Kelly. ìRepeated concussions can cause permanent damage to the brain.î
Immediate symptoms of concussion include headache; dizziness or vertigo; lack of awareness of surroundings; and nausea or vomiting. As time progresses, an athlete who suffers a concussion can develop mental dysfunction, sleep disturbance, light-headedness, and ringing in the ears.
The guidelines offer standards for managing the athlete, depending on the level of concussion and the athleteÃs history of concussion. The guidelines are also accompanied by two evaluation tools ñ a 3.5î x 7î palm card, designed for sideline evaluation of concussion by a coach or an athletic trainer; and a baseline examination, designed to provide a comparison between an athleteÃs mental status under normal circumstances, and after a concussion.
Carson has firsthand experience with the long-term effects that repeated concussions can have on an athlete. He makes a habit of carrying around a pad of paper to remember his daily plans, and occasionally experiences headaches and blurred vision.
ìYou donÃt think about the long term when youÃre living life on the field, banging helmets with a running back,î said Carson. ìIÃve been learning to live with the fact that I damaged my brain, and will have to find ways to compensate for that damage ñ if thatÃs possible.î
Radiosurgery Proven Safe, Effective Treatment for Trigeminal Neuralgia Radiosurgery is a safe, effective and noninvasive treatment for sufferers of trigeminal neuralgia, according to a study published in the March issue of the American Academy of NeurologyÃs scientific journal, Neurology. Trigeminal neuralgia, or tic douloureux, is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense facial pain. The pain, which is considered to be one of the most severe pain conditions humans experience, can occur spontaneously or can be triggered by a light touch to the face, chewing or changes in temperature. The study involved 60 trigeminal neuralgia patients who had not responded to drug treatment. Of those, 22 patients had also undergone conventional surgery with no response. All 60 patients underwent radiosurgery with the Gamma Knife, a device that delivers gamma radiation to a small, precise target in the brain without a surgical incision. The Gamma Knife uses 201 beams of radiation at doses too weak to harm normal tissue, but delivering a strong dose of radiation at the point where they intersect, according to Ronald Young, MD, medical director of the Northwest Hospital Gamma Knife Center in Seattle, WA, and study author. Of the 60 patients, 49 experienced complete or nearly complete relief of pain following the radiosurgery and at follow-up evaluations from six months to three years after the surgery. One patient who had previous facial sensory loss due to a tumor had a mild increase in facial numbness. No other patients experienced loss of facial sensation or any other complication from the treatment. Young said this treatment may supplant medical treatment for trigeminal neuralgia. ìCurrently the standard procedure is to treat patients medically first,î he said. ìThen if that is not effective or if patients experience side effects to the drugs, they are treated surgically. This approach is based on the fear of complications associated with surgery, such as hearing loss, facial palsy, wound infections, etc. The Gamma Knife treatment is noninvasive, itÃs virtually without complications and itÃs as effective as the other surgical treatments.î
The AAN is an association of more than 14,500 neurologists and neuroscience professionals dedicated to improving patient care through education and research.
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